Prostate artery embolization shows safety and symptom relief across 302 challenging BPH cases

Men with enlarged prostates who had run out of standard options — those with catheter-dependent urinary retention, kidney impairment, prior prostate surgery, or heavy medical comorbidity — experienced significant and lasting relief from a minimally invasive procedure called prostate artery embolization, according to a new single-center study of 302 patients published in CVIR Endovascular. The procedure, which blocks the small arteries feeding the prostate to shrink the gland from the inside, improved urinary symptom scores, objective flow measurements, and even sexual function scores, while producing only twelve adverse events across the entire cohort, none of them severe and none affecting sexual function.

While the guidelines now include the procedure among the options for benign prostatic hyperplasia, the authors note that guidance on its particular use-cases remains limited. Their analysis draws on patients treated between January 2015 and December 2024, all aged 45 or older, all with benign prostatic hyperplasia that was refractory to medication or for whom medication was contraindicated. The cohort combined patients enrolled in two open-label, non-randomized clinical trials — registered as NCT03052049 and NCT02026908 — with patients treated outside formal trials under identical inclusion and exclusion criteria, with few exceptions.

The technical approach was consistent across the cohort. Embolization was performed through femoral arterial access using 300 to 500 micrometer microspheres, guided in most patients by on-table computed tomography angiography and in a minority of earlier cases by cone-beam computed tomography. Bilateral pelvic-side embolization was achieved in 297 of the 302 patients, or 98.3 percent; in the five remaining cases, atherosclerosis or vessel tortuosity prevented access on one side, and in all five of those instances the treated prostatic side was noted to supply both halves of the gland, presumably through chronic compensatory changes. Every patient was treated as an outpatient, with a mean hospital length of stay of zero days, and the average procedural radiation dose was 3470 milligray.

The headline results are striking in their breadth. At nearly every follow-up point — patients were assessed at screening and at 1, 3, 6, and 12 months — the procedure produced statistically significant improvement in every subjective and objective measure examined. The International Prostate Symptom Score fell by 12.3 to 13.8 points, a reduction of 52.8 to 59.2 percent, and the IPSS Quality-of-Life score improved by 2.3 to 2.8 points, or 47.9 to 58.3 percent. Both the storage and voiding components of the symptom score improved at all time points. Clinical success, defined as at least a 25 percent reduction in symptom score or at least a one-point improvement in quality-of-life score, was achieved in 186 of 199 patients, or 93.4 percent, at six months, and in 151 of 162 patients, or 93.2 percent, at twelve months.

Objective parameters moved in the same direction. Peak urinary flow rate improved significantly at all measured time points, post-void residual improved significantly at one and six months, and prostate-specific antigen declined by 1.5 to 2.0 nanograms per milliliter — a 15.6 to 28.5 percent reduction — at all points where the data were collected. Prostate volume itself fell by an average of 16.9 percent at six-month follow-up, a change the authors report as highly significant. These laboratory parameters were assessed in the clinical-trial patients, since off-trial patients did not routinely undergo the same objective testing.

Perhaps the most consequential finding concerns sexual function, an area where the established surgical gold standard, transurethral resection of the prostate, carries well-documented rates of erectile dysfunction and retrograde ejaculation. In this cohort, the International Index of Erectile Function score improved significantly at every follow-up time point, by 3.2 to 5.7 points, or 15.6 to 27.8 percent. Ejaculatory function measures from the Male Sexual Health Questionnaire Short Form also improved significantly at nearly all time points, with questions covering ejaculation strength, semen volume, and bother from ejaculation difficulties all improving at every assessment, and question one, on ejaculation frequency, improving at one month. At no follow-up point did any sexual function parameter significantly worsen, and no sexual adverse events were observed. The authors argue that these results support recommending the procedure for patients who wish to preserve, and possibly improve, their sexual function.

The sub-analyses are where the study earns its title. Among the 171 patients whose prostates measured 80 milliliters or larger — 62.8 percent of the cohort — the procedure was safe and produced significant improvements comparable to those seen in patients with smaller glands, and in patients with very large prostates exceeding 150 milliliters, significant improvement appeared in every subjective and objective parameter at nearly every point, without an increase in adverse events. The 183 patients classified as medically comorbid, defined by a Charlson Comorbidity Index of four or higher, fared as well as less comorbid patients at nearly all time points, with the comorbid group actually showing significantly greater improvement at a few points. Because the procedure is performed under moderate or local sedation, the authors note, it avoids the risks of general or regional anesthesia that can exclude multimorbid patients from surgery.

The procedure also performed well in the hardest-to-treat scenarios. Among the 23 patients who had already undergone prior prostate surgery or intervention, improvements in symptoms and sexual function were not significantly different from those in treatment-naïve patients, and the adverse event profile remained comparable and favorable. Of the 38 patients who arrived dependent on an indwelling or frequent intermittent catheter for urinary retention, 29 — 76.3 percent — achieved complete resolution of catheter dependence, and when two additional patients who reduced their catheterization frequency are included, 81.6 percent achieved improvement or resolution. Among the 77 patients with pre-procedural renal insufficiency, defined as an effective glomerular filtration rate below 60 milliliters per minute per 1.73 square meters for more than three months, the procedure was safe and produced improvements that were statistically non-inferior to those in patients without renal insufficiency at nearly all points. And in a small but complete result, all nine patients who presented with gross hematuria of prostatic origin saw their hematuria resolve after treatment.

The safety record deserves emphasis. Twelve patients, or 4.0 percent, experienced adverse events, all graded as mild or moderate under the Society of Interventional Radiology classification: four cases of hematuria, three urinary tract infections requiring antibiotics, three cases of urinary retention requiring up to three straight catheterizations, one case of retention requiring an indwelling catheter for approximately one month, and one case of hematospermia. No severe or life-threatening events occurred, and the transfusion rate was zero percent.

The authors are candid about the study’s limits. It was a single-center, non-randomized investigation, and there was moderate attrition: at twelve months, excluding patients who had not yet reached that follow-up by the time of analysis, the non-response rate was 33.3 percent for symptom scores, 36.9 percent for erectile function scores, and 41.4 percent for post-void residual data. The large number of sub-analyses performed raises the risk of false-positive findings, and no patients were followed beyond twelve months, leaving the durability of the benefits in these specific populations an open question. Baseline comparisons between trial and non-trial patients, and between responders and non-responders, found the groups largely comparable, with the exception of a higher frequency of comorbid patients among clinical-trial participants and among those who completed twelve-month follow-up. Within those constraints, the study offers a detailed, real-world map of where prostate artery embolization fits — and, in several scenarios where formal guidance has been thin, suggests it may offer advantages that surgical alternatives cannot match.

Subject of Research: Safety and efficacy of prostate artery embolization for benign prostatic hyperplasia across challenging patient subgroups

Article Title: Who should be considered for prostate artery embolization: revisiting the urologic guidelines based on results from over 300 patients with benign prostatic hyperplasia

Article References: Knight, G. M., Varadhan, A., Benishay, E., Rivera-Rodríguez, D. M., Jenkins, K., Hohlastos, E., Salem, R., & Mouli, S. (2026). Who should be considered for prostate artery embolization: revisiting the urologic guidelines based on results from over 300 patients with benign prostatic hyperplasia. CVIR Endovascular, 9(1), Article 135. https://doi.org/10.1186/s42155-026-00703-w

Image Credits: AI Generated

DOI: 10.1186/s42155-026-00703-w

Keywords: prostate artery embolization, benign prostatic hyperplasia, lower urinary tract symptoms, AUA guidelines, urinary retention, sexual function, renal insufficiency, hematuria, minimally invasive therapy, adverse events, IPSS, interventional radiology